Adolescent Healthcare and the Resident Learner SIG: Finding Wellness in the Adolescent Medicine Rotation Experience

Caroline Barangan, MD, FAAP

Richard Chung, MD, FSAHM

Paritosh Kaul, MD, FSAHM

Goal

Leverage a growing community of professionals involved in resident education to promote mutual growth and effectiveness as medical educators of Adolescent Health

Objectives

After attending the SIG participants will be able to:• Describe the key elements that the ACGME

requires training programs to address in the area of Wellness

• Discuss strategies for incorporating resilience-promoting behaviors for residents during their adolescent medicine rotation

• Demonstrate means of role modeling healthy work-life balance and resilience behaviors for residents during their adolescent medicine rotation

Agenda

• Overview of the key elements that training programs need to address in the area of Wellness.

• Discuss how resilience-promoting behaviors can be incorporated into the adolescent medicine rotation for residents

• Use the framework of role modeling to discuss how educators can demonstrate a healthy work-life balance and resilience behaviors

• Share resilience-promoting resources and discuss how educators can advocate for and support their own Wellness

ACGME

As of July 1, 2017, the ACGME has mandated that Wellness be addressed as a Common Program Requirement for training institutions (VI.C. Well-Being): “In the current health care environment, residents and faculty members are at increased risk for burnout and depression. Psychological, emotional, and physical well-being are critical in the development of the competent, caring, and resilient physician. Self-care is an important component of professionalism; it is also a skill that must be learned and nurtured in the context of other aspects of residency training. Programs, in partnership with their Sponsoring Institutions, have the same responsibility to address well-being as they do to evaluate other aspects of resident competence.”

ACGME Common Program Requirements

• Revised June 10, 2018

• Effective July 1, 2019

Well- Being (ACGME)

• Psychological, emotional, and physical well-being are critical in the development of the competent, caring, and resilient physician and require proactive attention to life inside and outside of medicine.

• Well-being requires that physicians retain the joy in medicine while managing their own real-life stresses.

• Self-care and responsibility to support other members of the health care team are important components of professionalism; they are also skills that must be modeled, learned, and nurtured in the context of other aspects of residency training.

• Physicians and all members of the health care team share responsibility for the well-being of each other.

• For example, a culture which encourages covering for colleagues after an illness without the expectation of reciprocity reflects the ideal of professionalism.

• A positive culture in a clinical learning environment models constructive behaviors, and prepares residents with the skills and attitudes needed to thrive throughout their careers.

Background and Intent:

• The ACGME is committed to addressing physician well-being for individuals and as it relates to the learning and working environment.

• The creation of a learning and working environment with a culture of respect and accountability for physician well-being is crucial to physicians’ ability to deliver the safest, best possible care to patients.

• The ACGME is leveraging its resources in four key areas to support the ongoing focus on physician well-being: education, influence, research, and collaboration. Information regarding the ACGME’s ongoing efforts in this area is available on the ACGME website.

• As these efforts evolve, information will be shared with programs seeking to develop and/or strengthen their own well-being initiatives. In addition, there are many activities that programs can utilize now to assess and support physician well-being. These include culture of safety surveys, ensuring the availability of counseling services, and attention to the safety of the entire health care team.

Areas of Focus

• Quality of educational experience over volume

• Workplace safety

• Policies and programs for resident and faculty well being

• Residents must be given the opportunity to attend medical, mental health, and dental care appointments, including those scheduled during their working hours.

Areas of Focus

• Education in identification of the symptoms of burnout, depression, and substance abuse in others and themselves; how to assist those identified; how to seek appropriate care for self; alerting PD or designated person

• Provide access to tools for self-screening• Provide access to confidential, affordable mental

health assessment, counseling, and treatment• Policies and procedures in place to ensure

coverage of patient care when a resident cannot attend work. Policies must be implemented without fear of negative consequences for the resident who is or was unable to provide the clinical work

Concept in Adolescent Health

• Adolescent health professionals are in a position of cultivating wellness and resilience behaviors and attitudes among our patients : positive health behaviors, coping strategies, stress management, self care, etc.

• As we train our learners to deliver this key service to teens, we are also helping them develop these skills for themselves.

Role Model

• Teaches by example and commitment through promoting observation and reflection

• Might have brief contact with learner

Quality of Role Models

• Rated highly on feedback

• Professional attitude towards residents

• Creating a positive learning climate

• Not impacted by subspecialty and level of training

Good Clinical Teachers Likely to be Specialist Role Models: Results from a Multicenter Cross-Sectional Survey Lombarts K et al

Discussion

• What do you do as a role model to demonstrate

healthy work-life balance and resilience behaviors?

• What might you do?

• What will you do?

ACGME Resources

• https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being

• https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/Resources

Websites

• LEADER program for researchers https://medschool.duke.edu/about-us/faculty-resources/facultydevelopment/our-programs/leadership-development-researchers

• Clinical Leadership Program https://healthpolicy.duke.edu/duke-clinical-leadership-program

• Duke Department of Pediatrics Quality Program

• https://intranet.medschool.duke.edu/depts/pediatrics/SitePages/Quality%20Pro gram.aspx

• Duke Healthy Campus https://sites.duke.edu/healthy/

• Center for Healthy Minds – University of Wisconsin- Madison https://centerhealthyminds.org/join-the-movement/your-well-being https://centerhealthyminds.org/join-the-movement/workplace

• Greater Good Science Center- Berkley https://greatergood.berkeley.edu/

Websites• National Academy of Medicine, Action Collaborative on Clinician Well-being and Resilience

https://nam.edu/initiatives/clinician-resilience-and-well-being/

• Meditation and MBSR: https://mind-bodyhealth.osu.edu/ https://wexnermedical.osu.edu/integrative-complementary-medicine/resources KORU: https://korumindfulness.org/guided-meditations/ James Gordon: https://cmbm.org/self-care/ https://www.headspace.com/ https://www.calm.com/meditate http://marc.ucla.edu/mindful-meditations

• 3 Good Things: http://www.dukepatientsafetycenter.com/ https://www.youtube.com/watch?v=57ru-P7EuMw

• PDC Provider Empowerment Program https://intranet.dh.duke.edu/ent/pdc/HR/Pages/PEP.aspx

• Duke Integrative Medicine https://www.dukeintegrativemedicine.org/programs-training/

• Professional Development Seminar Series: https://medschool.duke.edu/about-us/faculty-resources/facultydevelopment/our-programs/professional-development-seminar-series

• ALICE program for mid-career women: https://medschool.duke.edu/about-us/faculty-resources/facultydevelopment/our-programs/alice-program

Books

• The Book of Joy- Dalai Lama, Desmond Tutu, Douglas Abrams (includes meditation practices)

• Medicine, Mindfulness and Humanity- Ronald Epstein (includes chapter on Organizational Mindfulness)

• Yoga Sparks- Carol Krucoff (simple and quick yoga practices)

• Peace is Every Step- The Path of Mindfulness in Everyday Life - Thich Nhat Hanh

• 50 Ways to Save Your Life During Residency (and beyond)- Ben Brown , MD

More Resources

• AAP Resilience Curriculum: https://www.aap.org/en-us/about-the-aap/CommitteesCouncils-Sections/Section-on-Hospice-and-Palliative-Medicine/Pages/ResilienceCurriculum.aspx

• AAP Section on Integrative Medicine. Mind-Body Therapies in Children and Youth. Pediatrics. 2016 Sep; 138(3). pii: e20161896. doi: 10.1542/peds.2016-1896. Epub 2016 Aug 22.PMID: 27550982

• Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, RakelD.Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med 2013; 412-420.doi: 10.1370/afm.1511

• McClafferty H, Brown OW. Physician Health and Wellness. Pediatrics 2014; 134:830835

• Palamara K, Kauffman C, Stone VE, Bazari H, Donelan K. Promoting Success: A Professional Development Coaching Program for Interns in Medicine. J Grad Med Educ. 2015 Dec; 7(4): 630-7. doi: 10.4300/JGME-D-14-00791.1.

• Shanafelt TD, Dyrbye LN, West CP. Addressing Physician Burnout The Way Forward. JAMA. 2017; 317(9): 901-902. doi: 10.1001/jama.2017.0076

• Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout Mayo Clinic Proceedings 2017 Jan; 92(1): 129-146. doi: 10.1016/j.mayocp.2016.10.004. Epub 2016 Nov 18.

More Resources

• West CP, Dyrbye LN, Rabatin JT, Call TG, Davidson JH, Multari A, Romanski SA, Hellyer JM, Sloan JA, Shanafelt TD. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med. 2014 Apr; 174(4): 527-33. doi: 10.1001/jamainternmed.2013.14387.

• Wright AA, Katz IT. “Beyond Burnout- Redesigning Care to Restore Meaning and Sanity for Physicians.” N Engl J Med. 2018 Jan 25;378(4):309-311.

• Sinsky, CA, Privitera, MR. “Creating a ‘Manageable Cockpit’ for Clinicians- A Shared Responsibility.” JAMA IM 2018 Mar 26. doi: 10.1001/jamainternmed.2018.0575.

• Abaza, MM, Nelson, KG. “Leading by Example: Role Modeling Resilience Helps Our Learners and Ourselves.” Acad Med 2018: 93:157-158.

• Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017. (Available at ihi.org)

• Bass, PF., Rodgriguez, GC. “Burnout: Pediatrician , heal thyself.” Contemporary Pediatrics 2018 June: 35(6).

Contact Information

caroline.barangan@nvpeds.com

richard.chung@duke.edu

paritosh.kaul@childrenscolorado.org